prospective correlation of symptoms and clinical grading in vernal keratoconjunctivitis patients...
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Prospective Correlation of Symptoms and Clinical Grading in Vernal Keratoconjunctivitis Patients
Srikant K Sahu, Shraddha Pawan Sureka, Sujata Das,Apurva Hardas
L V Prasad Eye Institute, Patia, Bhubaneswar, India.
None of the authors have any financial disclosure to make
Introduction• Vernal keratoconjunctivitis (VKC) is a chronic, bilateral,
inflammatory disease of the ocular surface
• Characterized by intense ocular itching, redness, stringy discharge & photophobia
Palpebral VKC Limbal VKC Mixed VKC
Problem
• The grading of VKC is subjective
• There is a mismatch between symptoms and signs – Leads to confusion in the allotment of a clinical
grade
• There is no universal way of grading the disease
Objective of the study
• To assess of the symptoms by Visual analogue scale and correlate it with disease severity graded by Bonini
Ref: Bonini S, et al. Vernal keratoconjunctivitis revisited. A case series of 195 patients with long-term follow up. Ophthalmology. 2000;107:1157–1163.
Methods
• Visual analogue scale:
Redness, itching, watering, photophobia, burning sensation, foreign body sensation, decreased vision
Each symptom given score of 0 to 10 – Added
• Disease severity by Bonini claassificationGrades 1, 2A, 2B, 3, 4Limbal, tarsal or mixed form
• Allergic tendency
Methods - Statistics
• Symptom score was correlated with disease severity as per Bonini classification
• Spearman’s rank correlation coefficient
• Multiple regression analysis
ResultsBonini grade - disease severity
No. of patients
1 19
2A 15
2B 15
3 9
4 2Form of disease
No. of patients
Palpebral 16
Limbal 20
Mixed 24
Age at presentation
10.7 ± 5.0 years
(Mean ± SD),
Median 10 years
Range, 3-25 years
Males: Females
49:11
Duration between
onset & presentation
3.2 ± 2.9 years
(Mean ± SD),
Median 2 years
Range, 0-12 years
Results – Symptom score & Correlation with disease severity
Symptom Mean
Median
Std. Deviation
Spearman r
P
Burning 2.9 3 2.8 0.225 0.084
Itching 6.7 7 2.3 -0.003 0.981
Photophobia
3.3 3 3.2 0.316 0.014*
Watering 5.4 6 2.8 0.126 0.338
Redness 7.2 8 1.8 0.172 0.189
FB sensation
2.0 0 2.8 0.109 0.407
Decreased vision
1.4 0 2.7 0.182 0.164* Significant correlation
Results – Symptom score & Correlation with disease severity
– Multivariate analysisSymptom Coefficie
nt95% Confidence intervals
P values
Burning 0.062 -0.066-0.191 0.335Itching -0.080 -0.231-0.071 0.292Photophobia 0.102 -0.001-0.206 0.053Watering 0.030 -0.088-0.149 0.609Redness 0.012 -0.168-0.191 0.898FB sensation -0.015 -0.149-0.118 0.819Decreased vision
0.028 -0.095-0.151 0.652
• Demographic data suggests that clinical profile of the disease in our setting varies as compared to the studies reported world wide
• Complications like keratoconus, limbal stem cell deficiency and corneal scarring is seen more commonly in our setting
• Photophobia is an important symptom
• Tendency for increased symptom score of photophobia to be associated with increased disease severity
• No other symptoms showed any correlation with disease severity
• Thus patients symptoms need separate grading
Discussion
• Clinical symptoms of VKC do not correlate with signs and need to be graded separately for objectively treating and prospectively assessing management.
• VAS scores can be easily used for grading symptoms and Bonini classification for grading signs. Allergy tendency would be recorded separately.
• This classification would need further studies for validation and and considering prospective plotting of each of the scores on a graph every 6 months.
Conclusions
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